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Clinical Features

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Clinical features of iron deficiency anemia depend on the severity of the anemia, age, comorbidities, and chronicity and speed of onset. In some cases, anemia is asymptomatic and diagnosed only after laboratory measurement of hemoglobin concentration.

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Common Symptoms

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Common Symptoms of Iron Deficiency With and Without Anemia

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Other Symptoms

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Physical examination of individuals with iron deficiency (with or without anemia) may be normal or may reveal:


Pallor, dry skin,

Koilonychia (Spoon nails) A deformity of the nails characterized by depression of the central part and elevation of the lateral aspect.

Atrophic glossitis Absence of the filiform papillae on the dorsal surface of the tongue, resulting in a smooth, glossy appearance with a red or pink background and associated with tongue pain and burning sensation.

Angular cheilitis Erythema, painful cracking, scaling, bleeding, and ulceration at one or both corners of the mouth.

Systolic murmur Best heard at the base of the heart, due to turbulence of blood flow across the aortic valve secondary to increased ejection fraction to increase oxygen delivery.

Tachycardia/hemodynamic instability in severe cases

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Clinical Findings

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Iron deficiency and anemia can also exacerbate symptoms and worsen the prognosis of medical conditions, including heart failure and ischemic heart disease. Additionally, preoperative anemia is correlated with postoperative morbidity and mortality.


Maternal anemia is associated with increased risk of maternal death, infection and hospitalization, and inhibited lactation. Adverse effects for the fetus include spontaneous abortion, premature delivery, and intrauterine fetal death, as well as increased risk of iron deficiency and ADHD in children. (4)  

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